Multiple sclerosis and pregnancy
Multiple sclerosis (also called MS) is an autoimmune disorder that affects the central nervous system (the brain and spinal cord). Autoimmune disorders are health conditions that happen when antibodies attack healthy tissue by mistake. Antibodies are cells in the body that fight off infections.
If you have MS, your body attacks the myelin sheath. This is a covering that protects your nerve cells, kind of like insulation around an electric wire. Damage to the myelin sheath slows down or stops messages between your brain and the rest of your body. This can cause mild to severe symptoms that affect your muscles, speech and vision. MS is usually mild, but over time some people with MS can’t write, speak or walk.
About 1 in 1,000 people in the United States has MS. Women are about 2 to 3 times more likely than men to have it. It’s usually diagnosed during childbearing years, between the ages of 20 and 40. But it can happen at any age.
The good news is that if you have MS and get the right medical care, chances are you can have a healthy pregnancy and a healthy baby.
How do you know if you have MS?
Signs and symptoms can include:
- Muscle weakness, stiffness or cramps
- Tingling, numbness or pain in your body
- Tremor (shaking) in your arms or legs
- Loss of balance
- Problems walking or moving your arms or legs
- Speech problems
- Vision problems
- Fatigue (feeling tired all the time)
- Bladder or bowel problems
- Thinking and memory problems
- Depression. This is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. It needs treatment to get better.
These signs and symptoms can be mild or serious. If you have any of them, tell your health care provider. She may refer you to a neurologist. This is a doctor with special training in diseases of the nervous system. The nervous system is made up of your brain, spinal cord and nerves. Your nervous systems helps you move, think and feel.
To check for MS, you may have these tests:
- Physical exam
- Blood tests
- Tests to see how your nervous system works (also called evoked potential tests)
- A spinal tap. This is when your provider pushes a small needle into your lower back to remove a small amount of cerebrospinal fluid. Cerebrospinal fluid is found around your brain and spinal cord. You provider sends the fluid for testing at a lab.
- Imaging tests, like magnetic resonance imaging (also called MRI). MRI uses magnets and computers to make a clear picture of the inside of the body. The test is painless and safe for you and your baby. MRI can show changes in the brain that are seen in MS, like abnormal tissue changes (also called lesions) and loss of brain tissue (also called atrophy).
MS can be hard to diagnose because there’s no specific test for it and the symptoms are different for each person. Some people have times when they’re feeling well (called remission) and times when new symptoms appear or old symptoms get worse (called flare-ups). Your health care provider looks at all of your test results and health information together to know if you have MS.
What problems can MS cause in pregnancy?
Having MS doesn’t seem to affect getting pregnant. During pregnancy, many women find their MS symptoms stay the same or even get better, especially during the third trimester. But if you have MS, you may be more likely than other women to have:
- A small-for-gestational-age baby. This means a baby who is smaller than normal based on the number of weeks he’s been in the womb.
- Trouble pushing your baby out during labor and birth. This can happen if your MS symptoms affect your pelvic muscles and nerves.
- A cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. Experts aren’t sure why women with MS are more likely than other women to have a c-section. It may be because of muscle problems that may delay labor.
Women with MS may be more likely to have a flare in the first 3 to 6 months after giving birth. But researchers think that being pregnant doesn’t affect the overall course of MS later in life.
How is MS treated?
There’s no cure for MS, but medicines can help control the symptoms. Many women don’t need medicines during pregnancy because their symptoms get better. If you have MS and are pregnant or thinking about getting pregnant, talk with your health care provider about the medicines you take for MS. Some may not be safe to use during pregnancy or breastfeeding.
For example, many people with MS take a medicine called beta interferon (Avonex®, Betaseron® and Rebif®). This medicine can help lessen flares and slow down the spread of nerve damage and the course of MS, but it’s not safe to take during pregnancy. Beta interferon may increase the risk of miscarriage (when a baby dies in the womb before 20 weeks of pregnancy) and stillbirth (when a baby dies in the womb before birth, but after 20 weeks of pregnancy). Cancer-fighting medicines called immunosuppressives are sometimes used to treat MS, but they’re also not safe to use during pregnancy. Your provider can switch you to a safer medicine.
Other therapies for MS are important, especially during pregnancy. For example, finding a support group for people with MS or talking to a counselor can be helpful. A support group is a group of people who have the same kind of concerns. They meet together to try to help each other. Exercise or physical therapy also can help. Physical therapy is an exercise program created just for you to help improve your strength and movement.
What causes MS?
We don’t know what causes MS, but genes may play a role. Genes are parts of your body's cells that store instructions for the way your body grows and works. Genes are passed from parents to children.
About 15 in 100 (15 percent) people with MS have one or more family members with MS. People who have a family history of MS are more likely to have MS than people who don’t. White people, especially whose families come from northern Europe, have the highest risk of having MS. People of Asian, African or Native American backgrounds have the lowest risk of having MS.
Researchers are studying to see if viruses, infections or other health conditions may be linked to MS. For example, if you have type 1 diabetes or thyroid disease, you may be slightly more likely to have MS than people who don’t have these conditions.
Your environment and lifestyle also may play a role in causing MS. For example, people who smoke are more likely to get MS than people who don’t. And MS is more common in people who don’t get enough sunlight or vitamin D. For example, it’s more common in areas farther away from the equator where there’s less sunshine. Sunlight helps the body make vitamin D.
For more information
National Institute of Neurological Disorders and Stroke
Last reviewed January 2014
Frequently Asked Questions
What is mononucleosis?
Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.
You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:
- Achy muscles
- Belly pain
- Fatigue (feeling tired all the time)
- Sore throat
- Swollen glands in your neck
If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.
There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.
Can Rh factor affect my baby?
The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.
If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.
If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.
I had a miscarriage. How long should I wait to try again?
Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.
Are gallstones common during pregnancy?
Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.